Adherence of community caretakers of children to pre-packaged antimalarial medicines (HOMAPAK(®)) among internally displaced people in Gulu district, Uganda

BACKGROUND: In 2002, home-based management of fever (HBMF) was introduced in Uganda, to improve access to prompt, effective antimalarial treatment of all fevers in children under 5 years. Implementation is through community drug distributors (CDDs) who distribute pre-packaged chloroquine plus sulfadoxine-pyrimethamine (HOMAPAK(®)) free of charge to caretakers of febrile children. Adherence of caretakers to this regimen has not been studied. METHODS: A questionnaire-based survey combined with inspection of blister packaging was conducted to investigate caretakers' adherence to HOMAPAK(®). The population surveyed consisted of internally displaced people (IDPs) from eight camps. RESULTS: A total of 241 caretakers were interviewed. 95.0% (CI: 93.3% – 98.4%) of their children had received the correct dose for their age and 52.3% of caretakers had retained the blister pack. Assuming correct self-reporting, the overall adherence was 96.3% (CI: 93.9% – 98.7%). The nine caretakers who had not adhered had done so because the child had improved, had vomited, did not like the taste of the tablets, or because they forgot to administer the treatment. For 85.5% of cases treatment had been sought within 24 hours. Blister packaging was considered useful by virtually all respondents, mainly because it kept the drugs clean and dry. Information provided on, and inside, the package was of limited use, because most respondents were illiterate. However, CDDs had often told caretakers how to administer the treatment. For 39.4% of respondents consultation with the CDD was their reported first action when their child has fever and 52.7% stated that they consult her/him if the child does not get better. CONCLUSION: In IDP camps, the HBMF strategy forms an important component of medical care for young children. In case of febrile illness, most caretakers obtain prompt and adequate antimalarial treatment, and adhere to it. A large proportion of malaria episodes are thus likely to be treated before complications can arise. Implementation in the IDP camps now needs to focus on improving monitoring, supervision and general support to CDDs, as well as on targeting them and caretakers with educational messages. The national treatment policy for uncomplicated malaria has recently been changed to artemether-lumefantrine. Discussions on a suitable replacement combination for HBMF are well advanced, and have raised new questions about adherence

Campaign 9 of the K2 Mission: Observational Parameters, Scientific Drivers, and Community Involvement for a Simultaneous Space- and Ground-based Microlensing Survey

K2's Campaign 9 (K2C9) will conduct a ~3.7 deg2 survey toward the Galactic bulge from 2016 April 22 through July 2 that will leverage the spatial separation between K2 and the Earth to facilitate measurement of the microlens parallax ${\pi }_{{\rm{E}}}$ for $\gtrsim 170$ microlensing events. These will include several that are planetary in nature as well as many short-timescale microlensing events, which are potentially indicative of free-floating planets (FFPs). These satellite parallax measurements will in turn allow for the direct measurement of the masses of and distances to the lensing systems. In this article we provide an overview of the K2C9 space- and ground-based microlensing survey. Specifically, we detail the demographic questions that can be addressed by this program, including the frequency of FFPs and the Galactic distribution of exoplanets, the observational parameters of K2C9, and the array of resources dedicated to concurrent observations. Finally, we outline the avenues through which the larger community can become involved, and generally encourage participation in K2C9, which constitutes an important pathfinding mission and community exercise in anticipation of WFIRST